Optimizing ICSI outcomes in women with PCOS: the influence of BMI, hormonal levels, and male fertility parameters

Objectives: Women with PCOS often experience significant difficulties in achieving spontaneous pregnancy. Intracytoplasmic sperm injection (ICSI) is a viable treatment option for these patients, offering an acceptable success rate. This study purposes to identify factors that may positively or negatively influence pregnancy rates in PCOS women undergoing ICSI and explore potential modifications to enhance successful pregnancy outcomes. Methods: The study included ninety sub-fertile couples with female partners with diagnosed PCOS. Comprehensive evaluations of the partners included medical history, physical examination, hormonal analysis, transvaginal ultrasound (TVUS), and seminal fluid analysis. All couples underwent ICSI. Pregnancy rates were determined by positive pregnancy tests 14 days after fresh embryo transfer, and participants were divided into two groups: pregnant and non-pregnant. Results: Of the 90 women who underwent ICSI cycles, 24 achieved pregnancies, resulting in a pregnancy rate of 26.66 %. Non-pregnant women had significantly higher body mass indices (BMI). Additionally, women with elevated cycle day 2 serum estradiol (E2) levels and low follicle-stimulating hormone (FSH) levels exhibited significantly lower pregnancy rates. Women whose male partners had abnormal semen parameters also demonstrated significantly lower pregnancy rates. Conclusions: Several factors negatively impact pregnancy rates in PCOS women undergoing ICSI, including high BMI, elevated E2, low FSH levels on cycle day 2, a lower number of mature oocytes, and male factor sub-fertility. Many of these factors can be mitigated through the use of ICSI, thereby improving the chances of achieving a successful pregnancy.